Результаты применения интрамедуллярного трансфизарного эластичного армирования у пациентов с тяжелыми формами несовершенного остеогенеза

Abstract

Introduction The work analyzes the results of using elastic opposite-directional transphyseal reinforcement for treatment of severe orthopedic complications in patients with osteogenesis imperfecta as well as the ways and their effectiveness to overcome the shortcomings of this technique. Material and methods The series included 24 patients. Among them, four patients had osteogenesis imperfecta of Type III, 19 were of Type IV, and one patient had Type VIII. The patients’ mean age was 14.4±2.8 years (range: 2-46 years). A total of 52 reconstructive surgical interventions were performed. Elastic intramedullary reinforcement was used in 83 segments. The combined osteosynthesis technique (the Ilizarov fixator and/or subperiosteal reinforcement) was used in 27 cases. Results Correction of deformities was achieved in all the cases. Consolidation at the osteotomy level was obtained after 26.2±7.8 days on the average (from 3 to 12 weeks postoperatively). The period of follow-ups was from 6 months to 4 years. Twenty-four complications were observed in 8 patients (33.3 % of cases). Twenty three additional interventions due to the problems of correction were performed in 20 patients (unplanned surgeries were necessary in 83.3 % of cases). The ability to stand in the vertical position and bear weight on the lower limbs with the use of auxiliary supports or without them was achieved in 22 cases out of 24 (91.7 %). Patients’ ambulation ability was evaluated with the Gillette scale and improved in 21 cases out of 24 (87.5 %). In all the cases, patient’s care facilitated, self-service capabilities improved, and patients’ social activity increased. A more comfortable position for sitting was achieved in 22 patients. In 100 % of the cases, pain reduced or disappeared by doingexercises or during walking, including exercise therapy or hygiene procedures. Conclusion The technique of transphyseal reinforcement using elastic titanium nails is indicated for deformity correction in children with severe types of osteogenesis imperfecta. Lower limb deformity correction and increased bone strength contributed to patients’ motor activity and improved their quality of life. Complications were not rare after surgical treatment but their timely correction enabled to retain the achieved anatomical and functional results. The use of a minimum fixation, the Ilizarov apparatus following corrective osteotomies and intramedullary reinforcement, assisted in achieving patient’s early verticalization and full weight-bearing on the operated limb as well as helped avoid a number of complications. Osseointegration of intramedullary implants with bioactive coating prevented their migration in the long-term period. Telescopic constructs of such nails should not be used in children under the age of 10 in order to avoid their locking in the medullary canal due to osseointegration.